【摘要】 目的:探讨多发伤合并胫腓骨骨折急诊外固定器治疗对多发伤的影响。方法:多发伤合并胫腓骨骨折(ISS≥15分)患者113例,其中男76例,女37例;年龄11~65岁,平均32.6岁。合并颅脑损伤62例,血气胸36例,腹腔脏器损伤23例,泌尿系损伤6例,合并其他部位骨折21例。急诊外固定器手术58例,择期外固定器手术34例,保守治疗21例。通过死亡率、急性呼吸窘迫综合征(ARDS)和脂肪栓塞综合征(FES)发病率、平均ICU监护时间等4项近期指标及骨折情况等远期指标对比3种不同治疗方法对骨折本身和多发伤治疗的疗效。结果:113例患者除4例死亡外,109例全部获得5个月~1年随访,急诊手术ICU监护时间为(9.0±1.5)d,ARDS、FES发病率为0和3.2%,明显低于另外2种方法(P(0.05)。急诊外固定器手术死亡率及其他并发症与其他2种方法相比差异无显著性意义。结论:多发伤合并胫腓骨骨折急诊外固定器治疗,具有手术简单、创伤小等优点,可显著减少多发伤患者ICU监护时间及部分并发症发病率,具有较高的临床意义和社会意义。更多还原

【Abstract】 Objective:To explore the effect of earlier external fixator operation for treating tibia and fibula fractures in patients with multiple injuries by retrospective study.Methods:The 113 multiple injured patients (ISS≥15)with tibia and fibula fractures included 76 male and 37 female with an average age of 32.6 years (ranged 11 to 65).The associated injuries included craniocerebral injury in 62 cases,Hemopneumothorax injury in 36,coelio-organ injury in 23,urinary system injury in 6 and other fractures in 21.Of all the patients,58 had emergency external fixator operation,34 had selective operation of external fixator and 21 had conservative treatment.Mortality and early complication incidence such as acute respiratory distress syndrome (ARDS),fat embolism syndrome(FES),intensive care unit (ICU) length of stay and the long-term complication of fracture were evaluated to contrast the three different methods.Results: Among 113 patients,4 were mortuus,all the other patients were followed-up for 5 months to 1 year.The mean ICU length of stay of patients in emergency external fixator operation was (9.0±1.5) days,the complications incidence of ARDS and FES were 0 and 3.2% respectively.The ICU stay and the two complications reduced significantly in emergency operation (P<0.05).There was no difference of mortality and the other complications between emergency external fixator operation and the other methods.Conclusion:Earlier external fixation for tibia and fibula fractures in patients with multiple injuries can reduce the ICU length of stay and complications incidence of ARDS and FES.更多还原